By all accounts, the maternal health care system is in crisis. Cesarean sections, which are more dangerous than vaginal birth and greatly lengthen recovery time, occur at a significantly higher rate than necessary. Some hospitals’ C-section rates are as high as 50%. Women routinely undergo unnecessary medical procedures, sometimes without their consent, or worse, against their express wishes.

If you have a particular vision for your birth, a birth plan might seem like a great way to counter a medical culture that often ignores pregnant women's wishes. But birth plans are not guarantees, and if this is your only strategy for getting the birth you want, you might be in for a disappointing experience.

Are Birth Plans Binding?

A birth plan is not a legally binding contract, and your doctor doesn't have to look at it. In fact, if you have an unusually long birth plan, your doctor might not even review it. If an emergency occurs, there might not be time to refer to your birth plan anyway.

Does this mean that birth plans are pointless? Absolutely not. The primary goal of a birth plan should be to help you clarify your wishes and needs. This document allows you and your partner to talk about the birth you want, and can open the door to productive conversations with medical providers — but only if you are willing and able to discuss the birth plan well before your due date.

Your Right to Informed Consent

Pregnant women often agonize about what their doctors will and will not “let” them do. The truth is that being pregnant does not take away your right to bodily autonomy. You have an absolute right to informed consent, and a doctor who performs a procedure on you against your will has committed an act of medical battery, which is a crime and a civil offense.

The only exception to this rule is when a doctor seeks a court order because they believe you are unfit to make a safe and informed decision. In an emergency situation, you still can make decisions. If you are unconscious, the doctor may either defer to your partner or their judgment. If you're worried about what might happen if you are unconscious or severely injured, consider creating a medical power of attorney that gives your partner decision-making authority in your absence.

In most cases, doctors don't force women to do anything. Your doctor cannot hold you down and force you to undergo a procedure. They can coerce you, however. You might hear language like:

  • “It's for the good of your baby.”
  • “We need to do this now.”
  • “I'm just going to make a small incision.”

If you do not actively say no and assert your wishes, the doctor has done nothing wrong. The burden is on you to protect your rights. It's not mean or rude to stand up for yourself.  In fact, it's good practice for the many times you'll have to stand up for your child in the future.

The Problem With Hospital Pre-Admission Forms

Informed consent may be an absolute, but one way hospitals get around it is with pre-admission forms. These forms often contain language requiring you to consent to any procedure your doctor deems medically necessary. Technically speaking, your doctor is still expected to get your consent. But if they do something without it, the hospital can later use these forms as evidence that you did consent.

Read the forms carefully. Cross out and initial anything with which you disagree, and add language to the effect that you insist on an absolute right to informed consent.

Getting the Birth You Want

The journey to a fulfilling birth that respects your wishes begins well before labor and delivery. Screen your providers carefully, and keep looking until you find someone who is a good fit. If you choose a provider who does not respect your wishes, you could spend your entire birth fighting with medical staff. Stress makes labor more difficult, and no laboring mother deserves to spend her birth fighting with doctors. Don’t wait until the last minute to select a provider who listens to and respects your wishes. Instead, try the following strategies:

  • Choose a doctor who listens.
  • Talk to your doctor about your desires early in pregnancy. If you encounter resistance, switch providers.
  • Read hospital policies carefully, since you may have a bad experience with a good doctor if the hospital staff is pushy.
  • Practice asserting yourself in a direct and calm fashion.
  • Make sure your partner knows exactly what you want and what you don't.

Though the ultimate goal is a healthy baby, birth is about much more than getting the baby out. Birth makes you a parent. This important rite of passage should be a positive experience, and all laboring individuals have an absolute right to dignity and respect, even when they disagree with their doctors.